Case of spontaneous closure and reopening of macular hole: a report

Dr Makiko Miyamoto at the Department of Ophthalmology, Takatsuki Hospital, Takatsuki-City, Osaka, Japan and colleagues have reported a rare case of spontaneous closure and reopening of macular hole. The case has appeared in the Journal of Medical Case Reports.

There have been several reports of spontaneous closure and reopening of a macular hole, however, in most of those cases, it was observed in eyes post vitrectomy. In the present case, both the initial onset and the recurrence involved impending macular hole, however, the optical coherence tomography findings differed at each examination. These findings suggest that some causes other than vitreous traction were responsible for both the spontaneous disappearance and recurrence of the impending macular hole in this present case.

A 76-year-old Japanese man presented with the primary complaint of decreased visual acuity (VA) in his right eye. Fifty years previously, he had been diagnosed as having macular degeneration of unknown origin in his left eye, yet no particular systemic diseases were found. In February 2017, he became aware of decreased vision in his right eye, and subsequently presented at our hospital on March 16, 2017. He had no particular past medical, social, environmental, family, or employment history of interest. Moreover, he was not receiving any medications and there were no lifestyle-related habits such as tobacco smoking and/or alcohol consumption prior to initial presentation. On examination, his uncorrected VA (UCVA) was 0.4 in his right eye and 0.01in his left eye, and the intraocular pressure in his right and left eyes was 10 mmHg and 11 mmHg, respectively. Both eyes were emmetropic; the axial length in his right eye was 23.62 mm, while that in his left eye was 23.25 mm. There were no abnormal findings in the anterior segment, even though he had a mild cataract in the ocular media. Optical coherence tomography (OCT) imaging revealed vitreous traction in the fovea centralis of his right eye. Moreover, foveal retinal detachment and cystic formation were observed, yet the retinal inner layer continued in a bridge shape, thus signifying IMH (that is, a stage 1B MH). In addition, chorioretinal atrophy was observed in his left eye. At the time of admission, there were no abnormalities in the physical and neurological examinations including pulse, blood pressure, and temperature. Laboratory findings, including complete blood count (CBC), liver and renal functions, and urine analysis, also revealed no abnormalities. With the consideration of a possible spontaneous remission, we decided to perform scheduled follow-up examinations.

At the initial follow-up examination performed 1 week later, the UCVA in his right eye was found to have improved to 0.6, and an OCT imaging revealed that the vitreous traction in the fovea centralis had disappeared and that the cystic formation had been reduced, leaving only retinal detachment in the fovea centralis. It should be noted that even though we did not perform fluorescein angiography, there were no obvious abnormalities of the retinal pigment epithelium in his right eye at that time.